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General NPI Number Information
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NPI Number | 1811718190
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Entity Type | Individual
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Provider Name | SHANICE WEATHERSPOON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 44075 JEFFERSON ST
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City | LA QUINTA
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State | CA
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Zip | 92253-4871
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Country | US
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Telephone | 760-772-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 22690 DOWNING ST
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City | MORENO VALLEY
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State | CA
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Zip | 92553-1879
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Country | US
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Telephone | 951-208-5959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 90182
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License Number State | CA
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